Fast Food, Race/Ethnicity, and Income

A Geographic Analysis
Jason P. Block, MD, MPH, Richard A. Scribner, MD, MPH, Karen B. DeSalvo, MD, MPH, MSc

Background: Environmental factors may contribute to the increasing prevalence of obesity, especially in
black and low-income populations. In this paper, the geographic distribution of fast food
restaurants is examined relative to neighborhood sociodemographics.
Methods: Using geographic information system software, all fast-food restaurants within the city
limits of New Orleans, Louisiana, in 2001 were mapped. Buffers around census tracts were
generated to simulate 1-mile and 0.5-mile “shopping areas” around and including each
tract, and fast food restaurant density (number of restaurants per square mile) was
calculated for each area. Using multiple regression, the geographic association between
fast food restaurant density and black and low-income neighborhoods was assessed, while
controlling for environmental confounders that might also influence the placement of
restaurants (commercial activity, presence of major highways, and median home values).
Results: In 156 census tracts, a total of 155 fast food restaurants were identified. In the regression
analysis that included the environmental confounders, fast-food restaurant density in
shopping areas with 1-mile buffers was independently correlated with median household
income and percent of black residents in the census tract. Similar results were found for
shopping areas with 0.5-mile buffers. Predominantly black neighborhoods have 2.4
fast-food restaurants per square mile compared to 1.5 restaurants in predominantly white
neighborhoods.
Conclusions: The link between fast food restaurants and black and low-income neighborhoods may
contribute to the understanding of environmental causes of the obesity epidemic in these
populations.
(Am J Prev Med 2004;27(3):211–217) © 2004 American Journal of Preventive Medicine

Introduction of calories attributable to fast-food consumption has

increased from 3% to 12% of total calories consumed

W
hile obesity has a range of causes from ge-
netic to environmental, the environment is a
key factor in the rapid development of the
obesity epidemic.1– 4 Increased food consumption may
be the most important of recent changes leading to an
obesogenic environment.5 Despite stable physical activ-
ity patterns during the last 20 years,6,7 Americans are
eating more,8 portion sizes have increased substantial-
ly,9 and inexpensive, high-calorie food is now
ubiquitous.
The growth of the fast-food industry has been an
important environmental inducement for increased
food consumption. In the last 20 years, the percentage
From the Tulane University School of Medicine, Department of
Internal Medicine (Block, DeSalvo), New Orleans, Louisiana, and
Louisiana State University Health Sciences Center, Department of
Public Health and Preventive Medicine (Scribner), New Orleans,
Louisiana
Address correspondence to: Karen DeSalvo, MD, MPH, MSc,
Department of Internal Medicine, Tulane University School of Med-
icine, 1430 Tulane Avenue, SL 16, New Orleans LA 70112. E-mail:
kdesalv@tulane.edu.
The full text of this article is available via AJPM Online at
www.ajpm-online.net.
in the United States.10 U.S. spending on fast food has
risen from $6 billion to $110 billion over the last 30
years.11
Fast food is notably high in fat content,12 and studies
have found associations between fast food intake and
increased body mass index (BMI) and weight gain.13,14
These same studies reported increased consumption of
fast food among nonwhite and low-income popula-
tions. Despite these relationships between income,
race/ethnicity, obesity, and fast food, limited research
to date has examined such associations on an ecologic
level. Morland et al.15 examined the relationship be-
tween fast-food restaurants, race/ethnicity, and wealth
as an ancillary analysis in a large ongoing study based in
the United States, and discovered no consistent rela-
tionship between wealth, measured with census tract
median home values, and fast-food restaurants. Addi-
tionally, they found no difference between the num-
bers of fast-food restaurants in black and white neigh-
borhoods. Reidpath et al.16 found diverging results in a
study addressing fast-food restaurant density and me-
dian individual income in Melbourne, Australia. Resi-

Am J Prev Med 2004;27(3) 0749-3797/04/$–see front matter 211

© 2004 American Journal of Preventive Medicine • Published by Elsevier Inc. doi:10.1016/j.amepre.2004.06.007
Table 1. Fast-food restaurant chains included in the ported onto a census tract map for Orleans Parish using
analysis MapInfo, version 6.2 (Matchware Technologies Inc., Troy NY,
2000). Previous small-area research guided the selection of
Number of census tracts as the model of a neighborhood in this
restaurants in
study.17,18
Name Orleans Parisha
The analysis was restricted to those census tracts with
Bud’s Broiler 5 (1) ⬎500 people, (2) ⬎2000 people per square mile, and
Burger King 16 (3) ⬍200 alcohol outlets per 1000 people. Researchers used
Chick-fil-A 3 alcohol outlet density as a proxy for commercial activity.
Church’s Chicken 11
These restrictions ensured that neighborhoods analyzed are
Domino’s Pizza 11
Kentucky Fried Chicken (KFC) 7 similar (i.e., urban and residential). Despite these restric-
McDonald’s 18 tions, fast-food restaurants in the excluded tracts are included
Papa John’s 4 in the analysis when these restaurants were located within the
Pizza Hut 9 “shopping area” (described below) of a neighboring census
Popeyes Chicken and Biscuits 23 tract that met the inclusion criteria.
Rally’s Hamburgers 9
Subway 23
Taco Bell 6 Levels of Analysis
Wendy’s Old Fashioned Hamburgers 10
Because of interest in the association between environmental
Total 155
factors and neighborhood demographics, researchers used
a
Parish is the unique Louisiana designation for a county; the bound- variables on two geographic levels. The first level was the
aries of Orleans Parish approximate the City of New Orleans.
census tract, where the population variables were measured.
These variables—the percentage of black residents and me-
dian household income— describe the demographics of the
dents of the lowest-income neighborhoods had 2.5
neighborhoods. The second level was the “shopping area.”
times more exposure to fast-food restaurants than those On this level were the environmental variables, which de-
living in the most affluent neighborhoods. The current scribe geographic exposures to those living in the neighbor-
study was an assessment of whether black and low- hoods: fast-food restaurant density (FFRD), alcohol outlet
income neighborhoods have increased geographic ex- density, presence of interstate or major state highways, and
posure to fast food restaurants. median home value as a proxy for property values.
We created “shopping areas” by producing buffers around
census tracts. These shopping areas, which included the area
Methods of the census tract and the area between the buffer and the
Definition and Identification border of the tract, provide a more realistic representation of
Researchers defined fast-food restaurants as chain restaurants geographic exposure than census tracts alone because people
that have two or more of the following characteristics: expe- often have to travel outside of their census tract to purchase
dited food service, takeout business, limited or no wait staff, goods. For example, many of the fast-food restaurants were
and payment tendered prior to receiving food. The national located just beyond the border of a particular tract and would
chain restaurants included had at least two restaurants in have been easily accessible to and patronized by many indi-
Orleans Parish (parish is the unique Louisiana designation viduals living within that census tract. However, these restau-
for a county; the boundaries of Orleans Parish approximate rants would have been excluded in the calculation of geo-
the City of New Orleans), and tend to be recognized as graphic exposure for that tract unless buffers were used. In
fast-food restaurants in the media and by the general public. fact, 62% of the census tracts have no fast-food restaurants
Additionally, one local fast-food chain that has five restau- located directly within their borders. However, only 2% of the
rants in Orleans Parish was included (Table 1). These criteria shopping areas with 1-mile buffers have zero fast food restau-
allowed for inclusion of the fast-food restaurants that cap- rants. For a sensitivity analysis, fast-food restaurant density was
tured the largest portion of the fast-food market. examined separately by creating buffers that were 1 mile and
Between August and October 2001, researchers identified 0.5 mile from the census tract borders.
restaurants by examining the log books for the Orleans Parish
Sanitation Department, which inspects all chain food outlets Variables
in the parish, by reviewing the local Yellow Pages phone book,
and by accessing restaurant locator engines on fast food chain Using multiple regression in SPSS (Graduate Pack 10.0 for
websites. Windows, SPSS Inc., Chicago IL, 1999), the geographic
association between FFRD and black and low-income neigh-
borhoods was assessed after controlling for other key environ-
Geocoding and Census Tract Inclusion Criteria
mental variables: alcohol outlet density, presence of highways,
Using geographic information system software, all fast food and median home value. These variables were included as
restaurants were geocoded in Orleans Parish.17 Geocoding is covariates in the model because they might influence the
a technique now widely used in public health research to placement of fast-food restaurants. All variables in the analysis
create electronic mapping of exposure to physical structures were log transformed, except for the dichotomous highway
such as toxic waste plants, alcohol outlets, or in this study, variable, to adjust for skew and to allow for elasticity calcula-
fast-food restaurants. The geocoded restaurants were im- tions. Elasticity calculations show that for a given percentage

212 American Journal of Preventive Medicine, Volume 27, Number 3

change in the independent variable, the dependent variable
changes by a certain percentage.
The dependent variable—FFRD—was calculated as the
number of restaurants per square mile in the shopping area.
FFRDs were evaluated separately for shopping areas with
1-mile and 0.5-mile buffers.
The primary predictor variables were the following popu-
lation variables: neighborhood percentage of black residents
and median household income. We used census tract esti-
mates for 1999, which were based on the 1990 census with
adjustments made by a commerical vendor of census data
(Claritas Trend Map, San Diego CA, 1999).
The environmental variables controlled for in the analysis
required geocoding, and were collected at the level of the
shopping area. Despite the classification of median home
value as an environmental variable, it was only available at the
level of the census tract.
We calculated the alcohol outlet density in the same
manner as the FFRD for each shopping area. Locations of
alcohol outlets were available in 1999 from the Louisiana
Alcohol Policy Needs Assessment Database.17 The database
characterizes alcohol outlets as on-sale (sites where alcohol is
sold for consumption on the premises, such as restaurants
and bars) and off-sale (sites where alcohol is sold for con-
sumption away from the premises, such as liquor or grocery
stores). A summary alcohol outlet variable was created includ-
ing both on-sale and off-sale outlets as a proxy variable for
commerical activity. Controlling for commerical activity in
this study was necessary because fast-food chains may place
restaurants in highly commercial areas due to zoning restric-
tions. Alcohol outlets are an ideal proxy measure for com-
mercial activity in Louisiana because these outlets include
bars, restaurants, liquor stores, grocery stores, drug stores,
and convenience stores.
The highway variable accounted for the presence of an
interstate highway or state highway in each shopping area.
The presence of highways may dictate fast food restaurant
location. Median home values also may influence the place-
ment of fast food restaurants because to control costs, chains
may locate on land with lower property values.
Regression Analysis
In the regression analysis, the researchers expected that the
environmental covariates would explain a large percentage of
the variance in FFRD. Therefore, a base regression model was
constructed with FFRD as the dependent variable and the
environmental variables as the predictor variables. The pop-
ulation variables—median household income and the per-
centage of black residents—were sequentially added to the
model to determine their effect on explained variance in
FFRD. All variables were part of the final model.
Results
Descriptive
Of the 184 census tracts, a total of 156 met the inclusion
criteria. Table 1 provides a list of fast food chains and
numbers of restaurants in Orleans Parish. The census
tract map of Orleans Parish in Figure 1 shows both the
placement of fast food restaurants as well as excluded
and included census tracts.
The mean FFRD for shopping areas defined with a
1-mile buffer was 2.48 fast food restaurants per square
mile; the mean FFRD for shopping areas defined with a
0.5-mile buffer was 2.54 restaurants per square mile. In
census tracts, the mean percentage of black residents
was 60.6%. The mean household income at the census
tract level was $25,450. Table 2 contains all relevant
descriptive information.
Bivariate Analysis
Spearman’s rank correlation coefficients were signifi-
cant when comparing FFRD in the shopping areas with
1-mile buffers to the neighborhood percent of black
residents and median household income (r ⫽0.160,
p ⫽0.046 for percent black; r ⫽⫺0.275, p ⬍⫽0.001 for
median household income). Similarly, correlations
were significant in shopping areas with 0.5-mile buffers
(r ⫽0.180, p ⬍⫽0.024 for percent black; r ⫽⫺0.266,
p ⬍⫽0.001 for median household income). Correla-
tion coefficients also were significant when comparing
FFRDs to the presence of highways and alcohol outlet
densities (all p values ⬍0.001).
Regression
Regression statistics are shown in Table 3. Using the
shopping areas with 1-mile buffers, the base model
(Model 1: alcohol outlet density, presence of highways,
median home value as predictor variables) explained
25.0% of the variance in FFRD. For Models 2 and 3,
median household income and the percentage of black
residents were added to the base model, respectively.
Both variables were significant predictors of FFRD after
controlling for the base model variables. Median house-
hold income explained an additional 3.3% of the
variance in FFRD above that of the base model (F test
change⫽7.87; p ⫽0.006), and the percentage of black
residents explained 19.1% of the variance above that of
the base model (F test change⫽52.7; p ⬍0.001). When
all variables were included together in Model 4, median
household income was no longer significant. However,
the percentage of black residents remained a signifi-
cant predictor of FFRD. Adding the percentage of black
residents to Model 2 explained an additional 16% of
the variance (F test change⫽44.2; p ⬍0.001).
The sensitivity analysis found similar results for the
shopping areas with 0.5-mile buffers. However, median
household income was not a significant predictor of
FFRD in Model 2 after controlling for the base model
variables.
The regression equation for shopping areas with
1-mile buffers demonstrates that for every 10% increase
in fast food restaurant density, neighborhood median
household income decreased by 4.8% and the percent-
age of black residents increased by 3.7%. The regres-
Am J Prev Med 2004;27(3) 213
Figure 1. Census tract map of Orleans Parish, Louisiana.

Table 2. Population and environmental variable

descriptives
Variable Mean SD
sion equation was solved to determine how many more Population
fast food restaurants are located in predominately black Percentage of black 60.6% 32.9%
neighborhoods compared to predominately white residents
Median household income $ 28,282 $17,211
neighborhoods. Neighborhoods with 80% black resi- Environmental: shopping areas with 1-mile buffer
dents had 2.4 fast food restaurants per square mile Fast-food restaurant density 2.48 1.6
compared to 1.5 restaurants per square mile in neigh- (restaurants/square
borhoods with 20% black residents. In this study, the mile)
mean size of a shopping area with a 1-mile buffer was Alcohol outlet density 30.8 25.7
(outlets/square mile)
6.2 square miles, with a range of 4.2 to 15.0 square Percentage of census tracts 81.4% 39.0%
miles. Therefore, for an average-sized neighborhood with highway(s) in
shopping area, predominantly black neighborhoods shopping area
were exposed to six more fast food restaurants than Median home valuea $101,224 $61,947
predominantly white neighborhoods. Environmental: shopping areas with 0.5-mile buffer
Fast-food restaurant density 2.54 2.0
(restaurants/square mile)
Discussion Alcohol outlet density 33.3 36.1
(outlets/square mile)
Fast-food restaurants are geographically associated with Percentage of census tracts 66.7% 47.3%
predominately black and low-income neighborhoods with highway(s) in
shopping area
after controlling for commercial activity, presence of Median home valuea $101,224 $61,947
highways, and median home values. The percentage of a
Median home value is an environmental variable but was available
black residents is a more powerful predictor of FFRD only at the level of the census tract.
than median household income. Predominantly black SD, standard deviation.

214 American Journal of Preventive Medicine, Volume 27, Number 3

Table 3. Regression models for shopping areas with 1-mile buffer
Two-
Coefficient sided p Adjusted r2
Model Variables included (␤) SE values of model
1 Alcohol outlet density 0.183 0.065 0.006 0.250
Highway 0.407 0.071 ⬍0.001
Median home value ⫺0.120 0.128 0.352
2 Median household income ⫺0.485 0.173 0.006 0.283
Alcohol outlet density 0.147 0.065 0.025
Highway 0.375 0.070 ⬍0.001
Median home value 0.367 0.214 0.089
3 Percentage of black residents 0.368 0.051 ⬍0.001 0.441
Alcohol outlet density 0.256 0.057 ⬍0.001
Highway 0.364 0.061 ⬍0.001
Median home value 0.631 0.152 ⬍0.001
4 Median household income ⫺0.195 0.158 0.221 0.442
Percentage of black residents 0.350 0.053 ⬍0.001
Alcohol outlet density 0.238 0.059 ⬍0.001
Highway 0.353 0.062 ⬍0.001
Median home value 0.790 0.199 ⬍0.001
SE, standard error.

neighborhoods (i.e., 80% black) have one additional
fast-food restaurant per square mile compared with
predominantly white neighbohoods (i.e., 80% white).
These findings suggest that black and low-income pop-
ulations have more convenient access to fast food. More
convenient access likely leads to the increased con-
sumption of fast food in these populations,13,14 and
may help to explain the increased prevalence of obesity
among black and low-income populations.
Researchers chose to evaluate geographic associa-
tions with FFRD in shopping areas with 1-mile and
0.5-mile buffers because of an uncertainty of how far
individuals were willing to routinely travel outside their
census tract to purchase food. The use of shopping
areas defined by 1-mile buffers seems more justified
based on reports regarding McDonald’s strategy for
franchise locations. McDonald’s has established a res-
taurant within a 3- to 4-minute trip for the average
American.19 Under the assumption that an individual
drives 25 miles per hour, a McDonald’s should be
located within approximately 1.5 miles of the average
American’s home. This distance is more consistent with
shopping areas with 1-mile buffers than those with
0.5-mile buffers, thereby potentially explaining the
more powerful results for the 1-mile buffer analysis.
Geographic Associations
Morland et al.15 reported contrasting results from the
current study, but their study diverged from this study
in several ways. First, they did not adjust their analysis
for other environmental factors that might influence
the placement of fast food restaurants. In the bivariate
analysis, a significant (although weak) relationship be-
tween FFRD and the percentage of black residents
existed, which increased substantially after controlling
for environmental confounders, including alcohol out-
let density, presence of highways, and median home
values. Second, they did not utilize shopping areas as
the area of geographic exposure for a neighborhood.
This method is important because many census tracts
do not have any fast food restaurants; however, people
residing in these tracts are still geographically exposed
to restaurants that are nearby but not within the tract
boundaries. By creating shopping areas, geographic
exposure is more effectively modeled. Third, the mea-
sure of wealth in the current study was median house-
hold income. No consistent relationships between
FFRD and median home value (the measure of wealth
used by Morland et al.15) were found in this study
either.
Other geographic research has shown associations
between neighborhood demographics and exposure to
consumer goods that contribute to negative health
consequences. As previously discussed, Reidpath et al.16
found similar results to this study when comparing fast
food restaurant density to median household income
among neighborhoods in Melbourne, Australia.
LaVeist and Wallace,20 as well as Scribner et al.,21 found
that liquor stores are more commonly located in pre-
dominantly black and low-income neighborhoods.
Other studies have found links between higher densi-
ties of alcohol outlets and increased rates of alcohol-
related outcomes, such as motor vehicle crashes22 and
assaultive violence.23 For food availability, Morland et
al.15 found that wealthy and predominantly white
neighborhoods have more supermarkets and fewer
neighborhood grocery stores than poor and predomi-
nantly black neighborhoods, an important finding be-
cause research indicates that supermarkets have more
“heart-healthy” foods when compared to neighborhood
grocery stores and convenience stores.24 Still others
have demonstrated a positive association between in-

Am J Prev Med 2004;27(3) 215

come and the availability of “healthful products” in
grocery stores at the community (city or county) level.25
Fast Food and Obesogenic Environment
Researchers have implicated environmental influences
on body weight as the primary contributor to the
development of the obesity epidemic.3,4,26 The in-
creased availability and consumption of food is a major
component of an increasingly obesogenic
environment.
Despite a decrease in the fat content (as a percentage
of total calories) of the average American’s diet, Amer-
icans are consuming more calories. The U.S. Depart-
ment of Agriculture reported an increase in the average
daily food energy intake from 1854 calories to 2002
calories between 1977–1978 and 1994 –1996.8 The
growth of “dining out” has significantly contributed to
this rise.10 In 1995, “away-from-home” foods provided
34% of total caloric intake and 38% of total fat intake
compared to 18% for both categories in 1977–1978.
Fast food is a major component of the away-from-home
food category, accounting for 12% of total caloric
intake for Americans in 1995 compared to only 3% in
1977–1978.
Fast-food consumption is also related to obesity, and
this relationship is strongest among low-income indi-
viduals.13,14 All of this supporting evidence, coupled
with the results of this study, suggests that fast food may
play a role in the obesity epidemic among low-income
and black communities.
Food Availability and Diet
These results suggest that black and low-income neigh-
borhoods have increased exposure to fast food.
Whether increased availability of fast food promotes
consumption is not the subject of this study. However,
theoretically, more convenient access to fast food cou-
pled with the decreased availability of healthy food in
black and low-income neighborhoods may increase
consumption of unhealthy foods. In keeping with this
theoretical construct, Cheadle et al.25,27 reported that
food availability in grocery stores was linked to the diet
of residents in the nearby areas. They found that more
“healthful products” in grocery stores were associated
with increased consumption of “healthful products” by
individuals living near those stores. Another study18
reported that black Americans consume one third
more fruits and vegetables for every additional super-
market found in their census tract.
Evidence also suggests that low-income and nonwhite
individuals do consume more fast food and unhealthy
food. French et al.13 noted that low income and non-
white ethnicity were associated with increased fast food
consumption. According to a British study, lower socio-
ecomic groups had diets with less vegetables and fruit,
216 American Journal of Preventive Medicine, Volume 27, Number 3
and more meat products, fats, and sugars compared to
higher socioeconomic groups.28
One explanation for these findings is that restaurants
and stores adapt their selection to the food preferences
of individuals living nearby. Therefore, they may not
offer healthy food options in black and low-income
neighborhoods because their market research indicates
that demand for such products is weak in those com-
munities. However, the opposite might also be true.
Food preferences could partly be dictated by available
selection in a neighborhood, especially because of the
lower access to transportation in black and low-income
communities.15,29 Likewise, because of limited financial
resources, black and low-income populations may sim-
ply seek out the most calories for the lowest price.
Limitations and Future Research
Despite an exhaustive effort to identify all fast-food
restaurants in Orleans Parish by searching telephone
directories, websites, and the Orleans Parish Sanitation
Department records, we may have missed some restau-
rants. However, it is unlikely that we under-counted
restaurants disproportionately based on demographic
characteristics of neighborhoods (i.e., nondifferential
selection bias).
This study’s definition of fast-food restaurants also
excludes some similar restaurants. Many local restau-
rants may have expedited food service but are not
connected to a chain, and some national chains may
have only one restaurant in Orleans Parish. In an
ongoing study of fast-food restaurants and full-service
restaurants, we have discovered that the fast-food res-
taurants included in this study comprise 67% of all
similar restaurants in Orleans Parish (including restau-
rants that do not fit this study’s inclusion criteria such
as single-site, fast-food restaurants, and chain, full-
service restaurants identified as serving fried chicken,
“po-boys,” sandwiches, fries, burgers, hot dogs, shakes,
pizza). These excluded restaurants may be located in
areas of the parish that have different demographic
characteristics than what was discovered for those res-
taurants included in this study. However, major fast-
food chains with a significant presence in the area
should serve the great majority of fast food meals and,
therefore, are most relevant to this analysis. Further-
more, no data exist to suggest that these other restau-
rants serve different areas of the parish.
Despite this study’s recognition of an association
between FFRD and black and low-income neighbor-
hoods, the directionality of the relationship cannot be
determined by this study. For example, neighborhood
demographics could be temporally shaped by the type
of restaurants in the area (making a neighborhood
more or less desirable) or other local features associ-
ated with these restaurants. Likewise, restaurants could
be established within neighborhoods that demograph-

What This Study Adds . . .
The connection between fast-food restaurants
and black and low-income neighborhoods may
contribute to the understanding of environmen-
tal causes of the obesity epidemic in these popu-
lations.
This study is the first to document that predom-
inantly black neighborhoods have higher densi-
ties of fast-food restaurants compared to largely
white neighborhoods.
Additionally, this study contributes to the body
of literature that has linked high fast-food restau-
rant density to low-income neighborhoods.
ically fit a restaurant’s target audience. Future research
should examine the association between fast food res-
taurants and neighorhood characteristics in a longitu-
dinal manner. Only by tracking the demographics of
neighorhoods over time and identifying the establish-
ment date of fast food restaurants can researchers
determine a temporal relationship.
This study’s focus on one parish/county limits the
generalizability of results. Orleans Parish has a very
large poor and black population. The link between
fast-food restaurants and these neighborhoods may
exist due to unique characteristics of this region. Fu-
ture research should attempt to duplicate this study’s
findings in diverse regions.
Studies should also examine the geographic associa-
tion between neighborhood fast-food restaurant den-
sity and obesity rates at both the neighborhood and
individual levels. The ability to geocode and use multi-
level designs now make this type of study possible.17
Conclusions
Fast-food restaurants are more commonly located in
black and low-income neighborhoods. This link may
suggest environmental exposure to fast food as a con-
tributor to the high prevalence of obesity in black and
low-income populations.
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